Characterization and mapping of upper extremity fractures in children by a tertiary hospital quarantine and post-quarantine period.

OBJECTIVES: This study aims to categorize and map the incidence and patterns of upper extremity fractures in children during and after novel coronavirus disease 2019 (COVID-19) quarantine and to identify changes in the demographic characteristics and mechanisms of these fractures. PATIENTS AND METHODS: Between April 2020 and April 2022, a total of 3,549 upper extremity fractures occurring in 1,028 pediatric patients (682 males, 346 females; median age: 7 years; range, 0 to 18 years) were retrospectively analyzed. Those who presented between the dates of April 1st, 2020 and April 1st, 2021 (quarantine) were included in Group 1, whereas those who presented between April 1st, 2021 and April 2nd, 2022 (post-quarantine) were included in Group 2. The fracture map also showed the fracture density and location. RESULTS: There were statistically significant differences in terms of age range between Groups 1 and 2 (p<0.01). The 6-11 age range was significantly higher in Group 1, and the 12-18 age range was significantly higher in Group 2. CONCLUSION: Reducing physical activity during quarantine reduces fractures, particularly in adolescents. The removal of restrictions increases fractures in children in this age range. These findings highlight the importance of considering age ranges and physical activity levels while planning safety measures to prevent injuries in children.

Dorsal Metatarsal Closed Wedge Osteotomy in the Treatment of Freiberg's Disease: A Prospective Observational Study.

The aim of this study was to prospectively evaluate the clinical and radiological results of dorsal metatarsal closed wedge osteotomy and headless screw fixation in the surgical treatment of Freiberg's disease.Thirty-four patients who were treated with dorsal metatarsal closed wedge osteotomy (DMCWO) for Freiberg's disease between February 2018 and March 2022 were included in the study. Patients were staged according to the classification system described by Smillie. Clinical outcomes were evaluated using the American Orthopedic Foot and Ankle Society's (AOFAS) lesser metatarsophalangeal-interphalangeal scale, the visual analog scale (VAS), the range of motion (ROM) of the metatarsophalangeal (MTP) joint, and a subjective patient satisfaction questionnaire. For radiological evaluation, the amount of preoperative shortening of the involved metatarsal, the amount of metatarsal shortening developed after osteotomy, and radiological recovery times were recorded.Thirty-two (94.1%) of the patients were female, and two (5.9%) were male. The average postoperative follow-up period for patients was 33.7 months (range: 24 months to 41 months). The mean AOFAS scores increased from 53.24 to 86.26 (p < 0.01). The mean VAS scores decreased from 8.59 to 1.79, and it was observed that the patients' pain improved significantly (p < 0.01). The mean ROM of the MTP joint increased from 48.76 degrees to 70.76 degrees (p < 0.01). An average of 2.5 mm (range 1 mm to 4.1 mm) of shortening of the metatarsal length developed postoperatively (p < 0.01). Arthrosis developed in 1 case (2.9%), and transfer metatarsalgia developed in 2 cases (5.8%).DMCWO is an effective treatment for both the early and advanced stages of symptomatic Freiberg's disease, leading to high patient satisfaction.

Unconventional mobility, conventional trauma: a comparative analysis of e-scooter-related fractures.

PURPOSE: The present research aimed to compare the different types of fractures to those caused by e-scooter use as well as reveal the severity of e-scooter injuries via an epidemiological analysis of fractures over the course of 6 months. METHODS: This retrospective study assessed medical records of patients with fractures or dislocations admitted to a Turkish level three trauma centre emergency orthopaedic department between June 2021 and January 2022. Using a two-group design, the first group encompassed all fractures and dislocations treated, while the second focused on e-scooter-related cases. Comparative analysis covered fracture patterns and factors within the e-scooter group, like demographics, injury mechanism, and timing. Surgical need and types were explored for e-scooter injuries. RESULTS: Among 4481 upper extremity fractures, finger fractures (27.47%) and distal radius fractures (25.37%) were common, while e-scooter-related cases exhibited radius and ulna shaft fractures (23.07%). Of 2400 lower extremity fractures, toe fractures (30.2%) and metatarsal fractures (19.66%) predominated, with e-scooter-related injuries largely featuring metatarsal fractures (30%). The surgery rate in all patients was 8.92%, whereas the surgery rate specifically for e-scooter injuries was 48.2%. Significantly greater occurrence of lower extremity fractures was evident in e-scooter-related injuries compared to upper extremities (p = 0.011). Collisions involving stationary or moving objects were linked to injuries in the lower extremities, whereas falls were primarily associated with injuries in the upper extremities. Treatment included surgery (48.2%) and conservative management (52.8%), with ORIF (35.7%) and CRIF (10.7%) utilised. CONCLUSION: E-scooter-related fractures and dislocations are typically more severe, often requiring surgery, compared to other fractures during the same period. The study emphasises the link between injury type and increased risk of lower extremity fractures or dislocations.

Reliability and Validity of the Turkish Version of the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joint Scale.

BACKGROUND: The American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP) scale is one of the most widely used outcome measures to evaluate hallux pathologies. This study aimed to translate the AOFAS Hallux MTP-IP scale into Turkish and investigate its psychometric properties. METHODS: The psychometric properties of the Turkish version of the AOFAS Hallux MTP-IP (AOFAS Hallux MTP-IP-T) scale were tested in 66 patients with hallux pathologies (52 women; mean age, 47.64 ± 12.75 years). Cronbach's alpha was used to assess internal consistency. The intraclass correlation coefficient (ICC) was used to estimate test-retest. Construct validity was analyzed with the Turkish version of the Manchester-Oxford Foot Questionnaire (MOXFQ), Visual Analogue Scale (VAS), and 12-item Short-Form Health Survey(SF-12). RESULTS: The AOFAS Hallux MTP-IP-T scale had adequate internal consistency (α = 0.71) and test-retest reliability (ICC2,1 = 0.93 for pain, ICC2,1 = 0.97 for function, and ICC2,1 = 0.97 for total score). The AOFAS Hallux MTP-IP-T total score has a moderate to strong correlation with VAS-activity and MOXFQ (ρ = -0.77, P = .001; ρ = -0.69, P = .001, respectively). The weakest correlation was found between the AOFAS Hallux MTP-IP-T and the SF-12 mental component scale (ρ = 0.31, P = .01). CONCLUSION: AOFAS Hallux MTP-IP-T has sufficient reliability and validity to evaluate Turkish-speaking individuals with a variety of forefoot pathologies including the hallux. LEVELS OF EVIDENCE: Level II.

Could percutaneous fixation with crossed Schanz pins be an alternative to open reduction in the treatment of intra-articular calcaneal fractures?

PURPOSE: Despite modern operative techniques and a considerable number of studies in the literature, the best treatment for calcaneal fractures remains an enigma for orthopaedic surgeons. The purpose of the study was to compare clinical and radiographic outcomes between anatomic calcaneal plate (ACP) fixation and crossed Schanz pin (CSP) fixation in the treatment of Sanders type II and III displaced intra-articular calcaneus fractures (DICFs). METHODS: Consecutive 65 patients (49 males, 16 females) who underwent surgery for DCIFs between January 2009 and February 2013 were retrospectively evaluated. The patients were divided into two groups as ACP and CSP according to the operative technique. The groups were compared in terms of demographic features, injury mechanism, operation time, fluoroscopy exposure, complications, full weight-bearing time, functional, and radiological outcomes. RESULTS: VAS-rest score did not differ significantly between the groups while the VAS-activity score was significantly higher in the CSP group (p = 0.001 and p = 0.645, respectively). Foot Function Index (FFI) was significantly lower, Maryland Foot Score (MFS) and the American Orthopaedic Foot and Ankle Society-hindfoot score (AOFAS) were significantly higher in the ACP group (p = 0.047, p = 0.016, and p < 0.001, respectively). While no difference was observed between the preoperative and the early post-operative (1st day) Böhler angle and Gissane angle, both were significantly higher in the ACP group at the post-operative last control (p < 0.001 and p < 0.001, respectively). CONCLUSION: Although crossed Schanz pin fixation shortens the operation time in displaced intra-articular calcaneus fractures compared to anatomic calcaneal plate, increased fluoroscopy exposure rates and low functional and radiological outcomes are disadvantageous of crossed Schanz pin. Anatomic calcaneal plate is still a better technique for preserving the alignment and elevating the displaced intra-articular segment for good to excellent mid-term results.

The common comorbidities leading to poor clinical outcomes after the surgical treatment of ankle fracture-dislocations.

BACKGROUND: The ankle fracture-dislocations are a significant traumatic incident for the bone and the soft tissue surrounding the ankle. Bone stabilization, joint immobilization, anatomic reduction and intervention for soft tissue protection should be performed as early as possible. The present study aims to determine the frequency of major comorbidities that can be seen after surgery in patients with ankle fracture-dislocations and the relationship between the trauma mechanism and clinical status with these comorbidities. METHODS: Thirty-eight patients (25 males, 13 females) who underwent surgery with ankle fracture-dislocations between May 2014 and February 2017 were evaluated retrospectively in this study. All patients were evaluated clinically and radiologically at least 24 months postoperatively. Arthrosis, synostosis, presence of the chondral lesion and AOFAS scores were detected for all patients. RESULTS: Mean AOFAS score was lower in open ankle fracture-dislocations than in closed dislocations (p=0.044). An accompanying osteochondral lesion (OCL) and increased patient age were found to be strongly associated with the development of arthrosis (p=0.005 and p=0.017; respectively). Four of 29 patients who received primer definitive surgery and four of nine patients who received step-by-step surgery had poorly calculated AOFAS scores (p=0.071). There was no significant relationship between dislocation direction and AOFAS scores (p=0.087). CONCLUSION: Clinical and functional results were found to be worse in patients with open ankle fractures, the rate of arthrosis increased with age, and the use of syndesmosis screw had a positive but not a statistically significant effect on clinical and functional outcomes.

The surgical outcomes of trans-scaphoid perilunate fracture-dislocations

1. Background/aim: Trans-scaphoid perilunate fracture-dislocation (TSPFD) is a rare injury. TSPFD is a fracture-dislocation that severely disrupts the anatomical structure of the carpal bones and may occur as a result of a high energy trauma of the wrist or a fall on an open hand. In this study, the aim is to provide midterm clinical and radiological evaluations of cases diagnosed and treated as TSPFD. Materials and methods: Eleven patients diagnosed with TSPFD as a result of wrist trauma were treated surgically and were analysed retrospectively. Clinical and radiological follow-up of the cases was evaluated. The mean age of the patients was 34 years. All patients were males with a dorsal dislocation according to Herzberg's perilunate fracture-dislocation classification. The mean follow-up time was 33 months. All of the cases were evaluated with preoperative and postoperative standard wrist anteroposterior and lateral radiographs. A dorsal approach was used in all cases. However, in 1 case a volar approach was also required. The Green and O'Brien evaluation scale modified by Cooney was used for the clinical assessment of pain, wrist range of motion, grip strength, and functional status as excellent, good, moderate, or poor. The wrist range of motion was evaluated goniometrically at the final check-up, and a mid-grade disability was observed compared with the uninjured side. A visual analogue scale was used to evaluate the pain. Results: Sufficient union was obtained in all cases with open reduction and internal fixation of the fractures. Grip strength was up to 77.5% of the other side. According to the modified Green and O'Brien clinical evaluation scale, 6 cases were evaluated as good, 3 cases were fair, and 2 cases were poor. No median nerve damage was determined preoperatively or postoperatively and there was no postoperative pin tract infection in any of the patients. Conclusion: This kind of injury represents complex biomechanical damage of the wrist anatomy. If it is diagnosed early and treated with open reduction and stable fixation, a functionally adequate and anatomically integrated wrist can be achieved.

Can radiology reflect patient satisfaction after hallux valgus surgery?

OBJECTIVES: This study aims to define the first web space length (FWSL) as a new radiologic parameter, which may reflect patients' subjective satisfaction and be associated with American Orthopedic Foot and Ankle Society (AOFAS) score as an objective parameter. PATIENTS AND METHODS: One hundred and fourteen patients (11 males, 103 females; mean age 43.4±13.2 years; range, 18 to 70 years) who underwent distal osteotomy between April 2010 and January 2018 were retrospectively reviewed. Patients were radiographically evaluated with pre- and postoperative standing foot anteroposterior and lateral X-rays. Hallux valgus angles (HVAs), intermetatarsal angle (IMA), and FWSL were measured. AOFAS scores were used for clinical evaluation. Satisfaction scores were obtained using a visual analog scale at the final follow-up. RESULTS: The relationship between postoperative AOFAS score changes and postoperative HVA changes was statistically significant (p=0.001, p<0.1). The relationship between postoperative AOFAS values and postoperative FWSL changes was statistically significant (p<0.001, p<0.1). No statistically significant relationship was detected between postoperative AOFAS values and IMA changes (p=0.101, p>0.05). The relationship between AOFAS scores and satisfaction scale was statistically significant (r=0.695; p<0.001, p<0.01). The relationship between the satisfaction scale and FWSL was statistically significant (p=0.005, p<0.01). CONCLUSION: The FWSL has an influence on patient satisfaction. It is correlated both with AOFAS scores and satisfaction scale. It can be used as a measurable parameter to detect patient satisfaction.

Alkaptonuria: Spontaneous Achilles tendon rupture: Case report.

Alkaptonuria is an autosomal recessive disease caused by the accumulation of homogentisic acid (HGA) products in the ligament, cartilage, skin and various organs due to the lack of HGA oxidase enzyme. In this article, we present a 61-year-old male patient operated on due to a diagnosis of spontaneous Achilles tendon rupture and diagnosed as alkaptonuria due to the intraoperative color of the tissues and the subsequent examinations. We also reviewed alkaptonuria and its accompanying pathologies in light of the literature.

Modified percutaneous fixation for displaced intra-articular calcaneal fractures.

OBJECTIVES: This study aims to review the results of surgically treated displaced intra-articular calcaneal fractures with a fast, less complicated, and modified percutaneous technique. PATIENTS AND METHODS: This retrospective study included 114 patients (86 males, 28 females; mean age 39 years; range, 16 to 66 years) admitted to our clinic for calcaneal fractures between May 2012 and June 2016 and operated using closed reduction and percutaneous fixation with two crossed Schanz pins. Trauma type, additional injuries, medical comorbidities, pre- and postoperative period, duration of operation, time to bone healing, complications, postoperative functional and radiological results were evaluated. RESULTS: The increase in the postoperative Bohler's angle measurements was statistically significant compared to preoperative values (p=0.001; p<0.01). According to Sanders classification, seven feet (5.3%) were type II, 76 feet (57.57%) were type III, and 49 feet (37.12%) were type IV. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 80.4 (range, 47 to 92). According to Sanders classification, the mean AOFAS scores were 81.25 for type II, 81.88 for type III, and 80.19 for type IV. Mean duration of operation was 8±1.5 minutes. CONCLUSION: Modified percutaneous fixation can give good results, even when open reduction is contraindicated. Maintaining the alignment and elevating the depressed intra-articular fragment may be sufficient for good mid-term results without anatomic reduction.

Microfracture provides better clinical results than debridement in the treatment of acute talar osteochondral lesions using arthroscopic assisted fixation of acute ankle fractures.

PURPOSE: Ankle arthroscopy is a useful tool for detection and treatment of accompanying intraarticular pathologies in acute ankle fractures. The purpose of this study was to compare the treatment results of talus osteochondral lesions (OLT) with debridement and microfracture in arthroscopy assisted surgery of acute ankle fractures. METHODS: Eleven consecutive patients who were treated with arthroscopic acute debridement and 14 consecutive patients who were treated with arthroscopic acute microfracture in the treatment of ankle fracture were included in the study. All patients were controlled clinically and radiologically in the postoperative period. Ankle pain was evaluated with the visual analog score (VAS), ankle functions were assessed with American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS), and osteoarthritic changes were analyzed with Van Dijk score. RESULTS: There was no significant difference between the groups in terms of age, gender, injury side and trauma mechanism (n.s). Mean time to surgery, fracture healing duration, first weight-bearing and full weight-bearing, follow-up period and Van Dijk score were all similar in both groups (n.s). The AOFAS score and VAS activity score were statistically significantly better in the microfracture group (p = 0.044 and p = 0.001). CONCLUSIONS: The clinical relevance of the present study is to define the acute treatment of the first osteochondral damage that occurred simultaneously with ankle fracture, to improve postoperative functional outcomes and to prevent post-traumatic osteoarthritis. Both debridement and microfracture yield good functional outcomes in the second year of the treatment. Microfracture ensures significantly more successful clinical results than debridement. LEVEL OF EVIDENCE: Level III.

Arthroscopic Treatment of Isolated Hoffa Fractures.

The goal of this study was to evaluate the results of a novel method, arthroscopic fixation of isolated Hoffa fractures.This is a prospective, case series and set at Level 1 trauma center. A total of eight patients with isolated Hoffa fractures who were operated by arthroscopic screw fixation method in the anterior posterior direction with 6.5 mm cannulated screws were followed up prospectively. Same surgical method used for all patients. All patients underwent the same rehabilitation program and active range of motion (ROM) exercises were started immediately. The International Knee Society (IKS) knee and functional scores, postoperative knee ROMs, and time of bone union were used as outcome measurements. Postoperative knee ROMs was compared with the contralateral healthy knee. The mean follow-up time was 29 months (26 - 41 months). At the final review, no significant difference (p = 0.159) was found between the ROM of healthy side and operated side of patients (153.1 ± 4.6 and 150 ± 3.8). The mean IKS knee and functional scores at 12 months were 87.2 ± 5.8 and 96.8 ± 3.7, respectively. Union was achieved in all patients at a mean duration of 3.8 months. Fracture side had no influence on the IKS knee scores, functional scores, and ROM (p = 0.846, p = 0.913, and p = 0.374, respectively). Concomitant intra-articular lesions identified in two patients (%25) during arthroscopy were one anterior cruciate ligament rupture and one medial meniscus tear. Patients undergoing arthroscopic Hoffa fracture fixation have excellent outcomes at average 29 months postoperatively with no apparent complications and no significant loss of ROM. Also 25% of patients had intra-articular injuries that were identified with arthroscopic technique that may have been missed with the open technique. The level of evidence was Level 4 (case series).

Medial mini-open versus percutaneous pin fixation for type III supracondylar fractures in children.

BACKGROUND: The present objective was to compare medial mini-open and percutaneous treatment of pediatric supracondylar fractures according to fluoroscopy time, duration of surgery, and iatrogenic ulnar nerve injury. METHODS: A total of 104 Gartland type III supracondylar humerus fractures were prospectively evaluated between 2011 and 2013. Patients were divided into 2 groups according to type of fixation. In Group A (41 patients), medial pin was inserted with mini-open incision with 2 lateral pins inserted percutaneously. In Group B (63 patients), all pins were inserted percutaneously. Mean follow-up time was 14.1±1.2 months in Group A, and 14.6±2.1 months in Group B. All patients were postoperatively evaluated for nerve injury with both motor and sensory function assessment. Length of surgery, total fluoroscopy time, fluoroscopy time for medial pin insertion, Baumann's angle, humeral capitellum angle, final carrying angle, and range of motion were recorded. RESULTS: Sensorial evaluation showed that Group A had 3 poor, and 1 fair results, and Group B had 2 poor, and 1 fair results. No statistically significant differences were observed, including no differences in either surgery or total fluoroscopy times between groups. However, fluoroscopy time during medial pin placement was significantly lower in the mini-open group. CONCLUSION: In conclusion, similar results of both techniques were observed, and both carry risk of iatrogenic ulnar nerve injury. Medial pin placement is easier and less demanding when used with mini-open technique.

Peroneus quartus: prevalance and clinical importance.

INTRODUCTION: The most common variant muscle of the ankle, peroneus quartus muscle, is located in the lateral leg compartment. In literature there is ambiguous nomenclature of this muscle because of its different origin and insertion sides. It is related to many pathologic conditions in the lateral ankle compartment but also it can be used as a tendon graft for reconstructive procedures. MATERIAL AND METHOD: We dissected 115 cadaver legs and investigated prevalence of peroneus quartus. We also present 2 year result of a patient who had torn superior peroneal retinaculum reconstructed with peroneus quartus tendon. RESULTS: The peroneus quartus muscle, with a number of different attachments, was present in 5.2 % (6/115) of the legs. It most commonly arose from the peroneus brevis muscle and inserted into the retrotrochlear eminence of the calcaneus. Associated pathologies are longitudinal degeneration and tear in the tendon of peroneus brevis. There is no any association between the prevalence of peroneus quartus and the height of retrotrochlear eminence or presence of peroneal tubercule (p > 0.05). But there is strong relationship between peroneus brevis degeneration and peroneus quartus existence (p: 0.03). We also defined a new type of peroneus quartus with a bifurcated insertion around the peroneus brevis. In literature our case report is unique because we present a patient who has torn superior peroneal retinaculum which is reconstructed with peroneus quartus tendon with 2 year follow up. CONCLUSION: Peroneus quartus may lead to some pathologic conditions (pain, snapping, tear, synovitis, etc.) in the lateral ankle compartment but it may be used to reconstruct some pathologic conditions. Orthopaedics, anatomists and radiologists should be aware of this accessory tendon structure because of its clinical importance.

Fourth and fifth carpometacarpal fracture dislocations.

OBJECTIVE: The aim of this study was to evaluate the mid-term results of patients with surgically treated 4th and 5th carpometacarpal (CMC) fracture dislocation. METHODS: The study included 9 CMC dislocation patients (9 males; mean age: 31.2 years, range: 20 to 40 years) treated with open reduction and internal fixation between 2008 and 2012. Mean follow-up period was 19.4 months. Mean interval between trauma and operation was 10.7 (range: 3 to 35) days. Radiological evaluation was performed at the final follow-up. Hand grip power was measured using a hand dynamometer and the injured and uninjured sides were compared. METHODS: There was a statistically significant difference compared to the injured side in hand dynamometer measurements (p<0.05). Three patients experienced pain during heavy labor. Among these cases, 2 had delayed diagnosis and 1 a comminuted CMC dislocation and was unable to return to his previous job. There were no recurrent dislocations or revision surgery due to complications. CONCLUSION: Early diagnosis and treatment of 4th and 5th CMC dislocation results in good anatomical and functional results. Delayed or incorrect diagnosis of this region causes severe radiological and functional problems. Detailed physical and radiological examination can prevent CMC dislocation from being overlooked.

Arthroscopic treatment of medial femoral condylar coronal fractures and nonunions.

Nonunion of medial femoral condylar coronal fractures are uncommon. In neglected Hoffa fractures despite nonunion, there is a risk of missing accompanying ligamentous and intra-articular injuries. Neither preoperative clinical examination nor magnetic resonance imaging showed these injuries before arthroscopy. Arthroscopy before internal fixation gives additional information and changes the surgical protocol for these fractures and nonunions.

Relationship between the size of bone marrow edema of the talus and ankle pain.

BACKGROUND: We sought to determine the changes in the size of the edema observed on MRI scans and its relation to the patient's pain during activity and pain during rest in bone marrow edema. METHODS: A total of 26 patients were followed up at 3-month intervals for a period of 1 year. During the follow-ups, magnetic resonance imaging scans of the patients' ankles were obtained; the scores obtained on the American Orthopaedic Foot and Ankle Society functional rating scale and visual analog scale were determined. The changes in these parameters and the correlation between them were examined. RESULTS: The size of the edema as observed on magnetic resonance imaging scans decreased, and the pain during activity and rest decreased. Although there is a correlation between the decrease in the edema size observed on magnetic resonance imaging scans and decrease in the pain during activity, there is no correlation between the decrease in the edema size observed on magnetic resonance imaging scans and the decrease in pain during rest. CONCLUSIONS: Patients can be informed more precisely, that the pain during rest and activity may not decrease after the third and sixth month, respectively. Magnetic resonance imaging may not alter after the ninth month, so it may not be necessary to be performed again.

[Crescentic distal metatarsal osteotomy for the treatment of hallux valgus: a prospective, randomized, controlled study of two different fixation methods]. / Halluks valgus tedavisinde kresentik distal metatarsal osteotomi: Iki farkli tespit yöntemiyle ileriye dönük, randomize, kontrollü bir çalisma.

OBJECTIVES: This study was designed to draw attention to a distal metatarsal osteotomy technique, which has been somewhat overlooked for the treatment of hallux valgus, and to compare the clinical and radiographic results of two different fixation methods. METHODS: The study included 16 feet of 13 patients (11 women, 2 men) who were treated with crescentic distal metatarsal osteotomy for mild-to-moderate hallux valgus (<35 degrees ). The patients were randomized to two fixation methods with two cross K-wires (group 1; 7 patients, 8 feet) and a compressive screw (group 2; 6 patients, 8 feet). The results were evaluated using the AOFAS (American Orthopaedic Foot and Ankle Society) clinical rating scale for hallux, and a visual analog scale for pain. Radiographic measurements included the hallux valgus angle (HVA), first/second intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA), before and 12 months after surgery. RESULTS: There were no significant differences between the two groups with regard to pre- and postoperative AOFAS scores and pain scores, which showed significant improvements in both groups at the end of one-year follow-up (p<0.001). The HVA and IMA significantly decreased from 32 degrees to 19 degrees and from 12 degrees to 6 degrees in group 1, and from 30 degrees to 17 degrees and from 12 degrees to 8 degrees in group 2, respectively (p<0.001). A similar improvement was also seen in the DMAA (p<0.001). Postoperative radiographic improvements were similar in both groups. One patient in group 1 underwent revision surgery with the same technique due to recurrence, and one patient in group 2 had delayed union. CONCLUSION: Crescentic distal metatarsal osteotomy may be an appropriate technique in the treatment of mild-to-moderate hallux valgus.

[Arthroscopic treatment of anterior-inferior shoulder instability]. / One-asagi omuz instabilitelerinin artroskopik tedavisi.

OBJECTIVES: We evaluated patients who underwent arthroscopic repair for posttraumatic, recurrent anterior-inferior glenohumeral instability with capsular laxity. METHODS: Seventeen patients (4 females, 13 males; mean age 27 years; range 18 to 40 years) were treated with arthroscopic Bankart repair and posterior capsular plication for posttraumatic, recurrent anterior-inferior glenohumeral instability with capsular laxity. Involvement was on the right side in 11 patients, and on the left in six patients. The mean duration from the first dislocation to surgery was 5.2 years (range 1 to 11 years). All the patients received conservative treatment before surgery. Range of motion was measured with a goniometer and muscle strength was measured manually. Apprehension test, Jobe apprehension-relocation test, and posterior apprehension test were used to assess instability. Preoperatively, all the patients were examined by anteroposterior and axillary radiographs and magnetic resonance imaging. Shoulder functions were assessed with the Rowe rating scale for Bankart repairs. The mean follow-up was 35.6 months (range 24 to 50 months). RESULTS: Instability recurred in three patients (17.7%). The Rowe score increased from a mean of 41 (range 15-45) to 78 (range 43-100) postoperatively. Functional results were excellent-good in 13 patients (76.5%), fair in one patient (5.9%), and poor in three patients (17.7%). One patient underwent arthroscopic revision following redislocation. Pre- and postoperative values for active forward flexion, external rotation, and internal rotation did not differ significantly (p>0.05). CONCLUSION: The results of arthroscopic Bankart repair and posterior capsular plication are satisfactory in the treatment of anterior glenohumeral instability with capsular laxity. However, the use of capsular plication with arthroscopic Bankart repair should be considered in selected cases.

[Early results of treatment with expandable intramedullary nails in femur shaft fractures]. / Femur saft kiriklarinda genisleyebilir intramedüller çivilerle erken dönem tedavi sonuçlari.

OBJECTIVES: We evaluated the use of expandable intramedullary nails, their efficacy, and short-term results in the treatment of femur shaft fractures. METHODS: The study included 20 patients (10 females, 10 males; mean age 31 years; range 15 to 75 years) who were treated with expandable intramedullary nails (Fixion intramedullary femur nail) for femur shaft fractures. All the fractures were closed and were rated as type 32 A or B according to the AO classification. The mean duration from injury to surgery was three days (range 4 hours to 8 days). The results were evaluated using the Thoresen criteria. The mean follow-up was 26 months (range 9 to 38 months). RESULTS: The mean operation time was 79 minutes (range 45 to 120 min). Union was achieved in all the patients in a mean of 12.8 weeks (range 10 to 20 weeks). According to the Thoresen criteria, the results were excellent in 15 patients, good in one patient, fair in three patients, and poor in one patient. The results in all type A middle diaphyseal fractures were excellent. Of four patients with A2-3 distal metadiaphyseal fractures, one patient had a good result with a valgus of 5 degrees , and three patients had a fair result with a valgus ranging from 8 degrees to 10 degrees , one of which also had 8-mm shortening. Delayed union, early or late infections, compartment syndrome, or bone necrosis were not seen. Of six patients who completed a follow-up of two years, the nails were removed in five patients, whereas removal was not possible in one patient due to a break in the upper part. CONCLUSION: Expandable intramedullary nails offer advantages in terms of ease of application and are less invasive than static nails and reamed applications. However, they may not provide adequate stability in metadiaphyseal regions and in fractures with fragments greater than 50%.